Tubed gastro-omental free flap for pharyngoesophageal reconstruction.

BACKGROUND: Malignant lesions of the pharyngoesophagus often require total laryngopharyngectomy and mediastinal dissection. As a result of the current treatment paradigms for advanced laryngopharyngeal cancers, it is common that the surgical field has been previously irradiated or exposed to systemic chemotherapy, resulting in fistula rates as high as 78% and mortality as high as 8%. The free vascularized tubed gastric antrum and the accompanying greater omentum offer a single-staged method of pharyngoesophageal reconstruction, with the added benefit of protection of the great vessels, the tracheal stump, and the mediastinal contents in a high-risk surgical field.

OBJECTIVE: To assess the gastro-omental free flap as a method of pharyngoesophageal reconstruction in patients who have been previously treated with multimodality therapy.

METHODS: Five consecutive cases of gastro-omental free flap reconstruction after total laryngopharyngectomy were retrospectively reviewed. Each case was assessed for intraoperative, perioperative, and postoperative complications at the primary site of reconstruction and the donor site. Patients were also evaluated for their ability to maintain an oral diet. Patients were followed up for a minimum of 6 months after surgery.

RESULTS: Five patients aged 44 to 70 years (mean, 59 years) underwent gastro-omental free flap reconstruction after total laryngopharyngectomy. Five patients had received previous external beam irradiation, 2 had received systemic chemotherapy, and 4 had undergone previous surgery. There were no fistulae or flap complications. Three patients were successfully treated with esophageal dilation for strictures sustained 2 to 5 months after surgery, and a third patient was successfully treated with conservative management for a partial gastric outlet obstruction sustained 2 months after surgery. One patient died 3 months after surgery of distant metastatic disease. The remaining 4 patients currently tolerate an oral diet.

CONCLUSION: The tubed gastro-omental free flap offers a safe method of reconstructing the pharyngoesophageal segment in a surgical field compromised by previous multimodality therapy.